Radiation Therapy for Inflammatory Breast Cancer

Abstract

Radiation therapy has always played an important role in the multidisciplinary management of inflammatory breast cancer (IBC). Before chemotherapy became available, radiation therapy was often the sole treatment modality, and although short-term locoregional control could be achieved in 50% of patients, nearly all patients rapidly developed metastatic disease and died. Prognosis has improved, and radiation is now most commonly used as adjuvant treatment after neoadjuvant systemic chemotherapy and a modified radical mastectomy.

IBC remains the most therapeutically challenging breast cancer clinical subtype for radiation oncologists. Because the disease tends to track through dermal lymphatics and recur at treatment field margins, treatment field designs must be comprehensive and broad. IBC also requires high radiation dosages. Our institution utilizes an accelerated hyperfractionation schedule, which data suggest may benefit patients with the highest risk, including those who are young, have poor clinical or pathological response to neoadjuvant treatment, and have close or positive margins after mastectomy. In addition, the subgroup of patients with triple-negative IBC (i.e., disease that lacks receptors for estrogen, progesterone, and HER2/neu) also maintains relevant local-regional recurrence risks despite aggressive radiation treatments. Accordingly, new strategies to selectively enhance radiation effects for patients with triple-negative IBC are needed.